From: Washington APCD
Sent: Thursday, June 29, 2017 2:40 PM
To: Washington APCD <>
Subject: News from the Washington All-Payer Claims Database
New WA-APCD welcomes data on 4 million Washingtonians
Historical health care claims for 4 million enrollees come through the door during WA-APCD’s first data submission period
After extensive work by participating health plans and the WA-APCD, doors closed this month on Round 1 of a new state resource that now houses four years of comprehensive health insurance data for more than four million Washingtonians.
Twenty-five mandated data suppliers submitted claims and eligibility files for the first round, covering the 2013-2016 service period. The data include medical, dental, and pharmacy claims.
“It was a huge task for the state’s health plans to get their data into the required format and to successfully submit their files on the project’s ambitious timeline,” said Thea Mounts, director of the WA-APCD program at the Washington Office of Financial Management (OFM).
“We thank the carriers for their cooperation in meeting the requirements of the WA-APCD statute and helping launch what is going to be a valuable data asset for health care transparency in the state.”
This round’s submissions include the entire Medicaid population, along with almost all of the Medicare Advantage market and more than half of all commercial enrollees. The lower proportion of commercial claims reflects the subset of coverage for which reporting was not mandatory, including self-funded accounts and coverage for federal employees and those serving in the military.
As a next step, the submitted data will be run through standardized quality and validation checks by Onpoint Health Data, the WA-APCD’s data vendor. In turn, the WA-APCD will produce a number of facility-specific cost metrics and quality scores drawing upon measures from the state’s Common Measures Set. Once this process is complete, we will proceed with a review and reconsideration process (details below) this fall. Ongoing quarterly data submissions begin in July.
Introducing Washington HealthCareCompare, WA-APCD’s consumer face
Empowering consumers to make higher-value health-care decisions ranked high in the Legislature’s list of goals for the WA-APCD program. Enter Washington HealthCareCompare, a new website that will allow consumers to shop for services by comparing cost and quality between providers.
The site, in development by Seattle’s Forum One communications group, features median prices, price ranges, medical practice and hospital quality ratings, and a cost calculator. Consumers can price-shop across 80 common medical services and find nearby doctor groups with associated quality ratings. Public launch is scheduled for 2018.
The site will report on the Washington State Common Measure Set on Health Care Quality and Cost, as specified in WA-APCD legislation. Visitors also will use this website to submit requests for WA-APCD datasets and products.
First round of data review and reconsideration opens this November
Physician organizations, hospitals, and other providers have the opportunity to review data that will be used to generate the publicly reported information before measure results are disseminated. For the first round of WA-APCD data work, this review process begins this autumn, after data validation and before the sale of data products and launch of the public website. Onpoint Health Data has prepared a web portal for providers to log in, inspect attributed data at the patient/procedure level, and request reconsideration where warranted. The WA-APCD team will begin outreach to providers in late summer to provide detail on the review service, which will occur over a four-week period.
Data policy, data release committee work underway
The WA-APCD program has filled out rosters for two committees inviting health care stakeholders to advise the WA-APCD on its policies and program implementation. The Data Policy Advisory Committee met for the second time this month to review the status of the program work plan, give early input on data product design and fees, and provide guidance on protecting the confidentiality of proprietary information, especially in reporting on geographic areas with fewer enrollees and providers.
The Data Release Advisory Committee convenes next month to begin assessing procedures to guide the release of data when the first generation of data products are ready in early 2018.
A list of committee members is available on the WA-APCD website.
“Group 2” data supplier up next for first-time submissions
With initial feeds from full-service carriers mostly complete, the WA-APCD data-submission focus now turns toward the collection of smaller private and public plans comprising “Group 2” data suppliers.
These suppliers include stand-alone dental insurers, Washington State Labor and Industries program (workers’ compensation), and commercial insurers who were not part of Group 1.
Group 2 suppliers had a June 21, 2017 deadline to register with the program. Intake of these data suppliers’ historical claims (2013-2016) runs from November 15, 2017, to January 14, 2018. See the WA-APCD data submitters' web page for more detail.
OFM opens rule-making process to clarify chemical dependency reporting
Aiming to provide clarity on chemical dependency/substance use disorder treatment reporting requirements, OFM filed a CR 101 (initial notice of proposed rule creation) on April 18, 2017. The proposed rule-making responds to concerns expressed by carriers about potential conflicts between federal regulations to protect patient confidentiality for these services and Washington state reporting requirements.
Rule-making continues on WA-APCD procedures for establishing fees for database products and on methods for calculating and displaying aggregate cost data. Full rule-making status updates are available on the rule-making section of the OFM WA-APCD project page.
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